Dysphagia in rheumatological disorders

Esophageal motility disorders in children with dysphagia: the utility of the Chicago classification

BACKGROUND

esophageal manometry is the standard criterion for the evaluation of dysphagia and the diagnosis of a primary motor disorder of the esophagus in adults and children.

AIMS

to describe the diagnosis according to the Chicago classification (CC) v3.0 in children with dysphagia, in whom an esophageal motility disorder was documented. The associated comorbidities were also determined.

METHODS

an observational retrospective study was performed of 54 patients evaluated for dysphagia, who had undergone a high-resolution manometry (HREM).

RESULTS

a normal HREM was found in 52 % (n = 28) of the children, whereas 48 % (n = 26) had some esophageal motility disorder. The most frequent diagnosis was ineffective esophageal motility and achalasia. Excluding previously healthy children, most children had a history of autoimmune disease and intellectual disability.

CONCLUSIONS

an esophageal motor disorder can be diagnosed in nearly half of infants and children with dysphagia. In this study, all esophageal diseases could be classified according to the CC v3.0. HREM should be considered for the evaluation of children with dysphagia, in addition to other studies.

The prevalence of dysphonia and dysphagia in patients affected by immunomediated diseases and the role of psychometric tests

This cross-sectional investigation examined the prevalence and severity of dysphonia, globus pharyngeus, and dysphagia in patients affected by immunomediated (IM) diseases. Seventy subjects were administered the Voice Handicap Index (VHI) (scale 0-4), Glasgow-Edinburgh Throat Scale (GETS) (scale from 0 to 7) for globus pharyngeus assessment, and modified Swallowing Outcomes After Revised Laryngectomy (SOAL) (scale 0, 1, 2) to test swallowing symptoms. VHI: the mean percentage of answers with a score greater than 1 (corresponding to a frequency of situation's occurrence "sometimes," "almost always," or "always") was 25.7, 26.7, and 44.1% for functional, emotional, and physical groups of sub-items respectively. GETS: the mean percentage of answers with a score ≥ 3 was 60.85%, significantly higher if compared with that of answers with a score < 3 (40.14%). The mean percentages of answers with a score 0-2, 3-4, and 5-7 were 40.1, 16.7, and 43.7% respectively. SOAL: a mean of 57.9% of answers gained a symptomatic score (1 ["a little"] or 2 ["a lot"]) and 41.9%, the score 0. The difference was statistically significant (p < 0.05). The first two most recurrent items with a score 2 ("a lot") were "Do you have a problem swallowing dry food?" (46%) and "Do you have a problem swallowing solid food?" (36%). The study represents the first to describe the globus pharyngeus symptoms in IM population. Moreover, it allows to confirm the recurrence of dysphonia and dysphagia in this type of patients. Particularly, it has been demonstrated that the alteration of swallowing function is related to solid and dry food. The self-assessment questionnaires proved as a useful tool to early detection of dysfunctions in order to avoid further deterioration of quality of life and to prevent serious life-threatening complications.

The Videofluorographic Swallowing Study in Rheumatologic Diseases: A Comprehensive Review

Autoimmune connective tissue diseases are a heterogeneous group of pathologies that affect about 10% of world population with chronic evolution in 20%-80%. Inflammation in autoimmune diseases may lead to serious damage to other organs including the gastrointestinal tract. Gastrointestinal tract involvement in these patients may also due to both a direct action of antibodies against organs and pharmacological therapies. Dysphagia is one of the most important symptom, and it is caused by failure of the swallowing function and may lead to aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. The videofluorographic swallowing study is a key diagnostic tool in the detection of swallowing disorders, allowing to make an early diagnosis and to reduce the risk of gastrointestinal and pulmonary complications. This technique helps to identify both functional and structural anomalies of the anatomic chain involved in swallowing function. The aim of this review is to systematically analyze the basis of the pathological involvement of the swallowing function for each rheumatological disease and to show the main features of the videofluorographic study that may be encountered in these patients.

Evaluation of Swallowing Functions in Patients with Sjögren's Syndrome

Patients with Sjögren's syndrome (SS) manifest symptoms such as dry eyes, dry mouth, and dysphagia. This study aims to evaluate the swallowing functions of the patients with SS. 69 patients with SS (65 females, 4 males) and 40 healthy individuals (33 females, 7 males) were included as study and control groups, respectively. Mean ages were 52.86 and 48.25 years for study and control groups, respectively. Swallowing functions were evaluated by fiberoptic endoscopic evaluation of swallowing (FEES). All the patients underwent FEES and were given 3, 5, and 10 ml water, yogurt, and fish-shaped crackers twice, respectively. The presence of bolus control, residue, penetration, and aspiration were evaluated. Additionally, certain types of foods triggering the dysphagia, any difficulties in bolus control, need to clean the throat, sensation of having a lump in the throat, sensation of choking, and xerostomia were included in the questionnaire. The MD Anderson Dysphagia Inventory and the Beck Depression Inventory were administered to patients. Considering the presence of residue with yogurt and fish cracker, there was a significant difference between groups (P < 0.05). Penetration was present in two patients in the study group; however, the difference was not significant (P > 0.05). Regarding the MD Anderson Dysphagia Inventory, the average scores were 48.18 ± 13.21 and 87.6 ± 10.67 for study and control groups, respectively, and a statistically significant difference was detected (P < 0.05). Regarding the Beck Depression Inventory, the average scores were 11.83 ± 9.37 and 8.03 ± 6.84 for study and control groups, respectively (P < 0.05). SS affected the swallowing functions significantly. The presence of residue with yogurt and cracker was the most obvious finding, whereas penetration/aspiration was not clinically significant. Swallowing dysfunction reduced the quality of life in patients with SS.